Request for Training Exemption/Waiver Form

Individuals may be exempt from BNL required training courses due to the knowledge and skills acquired through previous
course work or work experience. Exemptions may be granted at the discretion of the appropriate Responsible Requirement
Manager for completed equivalent courses, professional experience, or college courses and degrees. The Responsible
Requirement Manager is the individual who owns the requirement that generates the course need (i.e., the point of contact for
the subject area). If unsure of the responsible manager, forward the documents to the Training and Qualifications Program
Office.

Exemption Request for:

_______ _______________________________ ___ _______

Print Name Life/Guest No.

Course Title(s) and Number(s) from which you should be exempt:

Radiological Worker 1-classroom training____________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Explain why you should be exempt:

Successfully completed training at another DOE facility _____________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Documentation Attached:

Copy of DOE training certificate ________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Responsible Requirement Manager Approval :

__________________________________________________________
Print Name

_____________________________________________________ ________________________
Signature Date

Issue Date: __________________________ Expiration Date:___________________

Upon Approval, Send to Training Office (Bldg. 400B)

3.5/1i01e011.doc 1 (07/2007)
Note toTraining: Please contact when entered into BTMS. Ext 7461 or pheotis@bnl.gov

3.5/1i01e011.doc 2 (07/2007)